Tele-rehabilitation for the arm after stroke.

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Stroke is a major cause of disability worldwide, with 5 million people left permanently disabled. In Australia, total lifetime cost burden of first-ever stroke was estimated to be more than A$2 billion. A large contribution of these costs result from out-of-pocket expenses, informal care, and productivity losses associated with stroke. Loss of upper limb function contributes significantly to stroke-related disability and reduced independence. Functional recovery of the paretic upper limb after stroke continues to be one of the greatest challenges faced by rehabilitation staff. Yet despite a wealth of research showing that recovery of function is driven by repetitive task-specific training, rehabilitation of the arm and hand is given lower priority than retraining of walking. The major barriers include limited rehabilitation resources, difficulties with travel to rehabilitation facilities, and, for more severely impaired patients, the need for external assistance or guidance. We now propose to conduct a randomised controlled trial of in-home based tele-rehabilitation to actively exercise the affected upper limb in chronic stroke survivors using inexpensive, commercially available devices that enable participants to play computer games that encourage arm use and that can be progressed in level of difficulty. An on-line cognitive training program will be the active control intervention. We have previously shown that use of such devices in a centre-based program leads to improved arm function and quality of life. A parallel cost-effectiveness study will be conducted. If this intervention is found to be effective and cost-effective, it could be readily implemented as a practical, inexpensive, and motivating program of upper limb rehabilitation for stroke survivors in their own homes.

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